Hepatitis A

You hear it on the news. "Hepatitis outbreak reported at local restaurant". Or perhaps you get a letter from the school health nurse saying, "a cafeteria worker is infected with hepatitis A. Your child must have a shot to prevent the illness from spreading." These are not uncommon scenarios. Many parents have heard of this illness, but do not know much about it. There are many misconceptions about hepatitis A. Here is Dr. Sears guide to helping you understand this illness, and what to do if you or your children are exposed to an outbreak.

Yes. Hepatitis B and C are completely different illnesses and viruses than A. B and C are transmitted by contact with infected blood and can cause chronic, lifelong, liver damage. Hepatitis A is not transmitted by blood, and does not cause chronic liver damage or chronic disease. Your child probably received a Hepatitis B vaccine during infancy.

It is an illness that is caused by the hepatitis A virus. The virus infects the stomach, intestines, and liver. It varies in its degree of severity and symptoms depending on the age of the infected person:

• Children 6 years and younger. In this age group 70% of the cases are silent; there are no symptoms, not even fever. The illness comes and goes harmlessly, and nobody is even aware of it. The other 30% of children who catch this illness may have fever, fatigue, body aches, poor appetite, stomach pain, nausea, and perhaps vomiting and diarrhea. Approximately 5% of cases will have jaundice (yellow skin and eyes). For these children who do have symptoms, they are often mild. Occasionally, a child may have these symptoms on and off for a few weeks, but this is rare. Virtually all cases in this age group pass with no long-term complications.
• Children 6 years to 12 years. In this age group, 65% of children who catch the illness will show symptoms. These symptoms include fever, fatigue, body aches, poor appetite, stomach pain, nausea, and maybe vomiting and diarrhea. Many cases will have mild symptoms, but some will have moderate symptoms that can come and go for a few weeks. Almost half the cases with symptoms will also have jaundice. The illness basically acts like a long stomach flu. There are virtually never any long-term complications in this age group.
• Teenagers and adults. This age is where the disease is more troublesome. Most cases will experience the above symptoms, and the symptoms may be more pronounced and last longer. 70% of cases will have jaundice. Rarely, the disease can come and go for six months. Severe liver damage occurs very rarely.

Many people, by the time they are adults, will have caught this illness at some time during their life, and therefore have natural immunity.

The virus is excreted in the stools of an infected person. The virus then gets on the persons hands if the hands are not properly washed. The person does not have to be acting sick in order to be contagious. In fact, the virus is most contagious in the stools 1 to 2 weeks before the person even starts feeling sick, and this contagiousness continues approximately one week after symptoms have started. The virus can continue to pass in the stools for 1 or 2 weeks after this, but it is less contagious. The incubation period (the time you are exposed to the time you start feeling sick) averages 30 days, but can be anywhere from 15 to 50 days. Because of this pattern of illness, Hepatitis A can spread through childcare centers from diaper changing before anyone really knows what is happening. Restaurant outbreaks also occur from an infected person's hands contaminating food or beverages. The illness can pass through families easily.

A blood test can show two things: 1. If your child has been exposed to the illness in the distant past and now has immunity. 2. If he currently has the illness.

Please read the above section "What is Hepatitis and what are the symptoms". It's not serious in children, but can be in adults.

There are no actual anti-hepatitis medications. You can support and treat any of the bothersome symptoms of the illness. The main objective during cases of Hepatitis A is to identify all cases and possible exposures so that further spread of the disease can be prevented.

Yes there is, but it has not been a part of the routine recommended schedule until the year, 2000. It is only approved for children 2 years and older, and adults. In 2000, this vaccine became recommended for routine use in areas where Hepatitis A is prevalent. In the United States, this primarily only includes the Northwestern and Southwestern states. In the next few years, this vaccine may become more routine, but as of yet, most pediatricians are not routinely giving it. The hepatitis vaccine that your child already got as an infant is for Hepatitis B, not A.

Ask your doctor, or call the local public health department, to find out how prevalent this disease is in your area. If it's not, then you don't necessarily need this vaccine.

The first thing to do is to find out as many details as you can about the exposure. Use the guidelines above to determine if your child was around the person during the contagious period, and whether or not your child truly ate or touched something that may have contained the virus. Your doctor or public health department will help you determine if your child is at risk.

Hepatitis A vaccine. This is not known to help prevent the illness if you are already exposed. This is different than the immune globulin discussed next.

Hepatitis A immune globulin. This is an injectable serum that contains antibodies to hepatitis A. If given as a shot in the muscle less than 2 weeks after being exposed, it can prevent the disease from occurring. Before deciding to get this shot, however, consider these two things:

1. The antibodies are extracted from donated blood units, and then pooled together as concentrated Hepatitis A antibodies. One dose of this serum comes from many different donated blood units. Although it is tested very well, it many not be 100% safe.
2. How risky is the disease itself? For children, it is usually a mild illness. For adults, it can be more difficult to go through. For people who already have liver disease for some other reason, this illness can be very serious. You should only consider getting this immune globulin if the risk of severe illness to you or your child is high.

   You should discuss this issue with your doctor to decide the best course of action for your family if you are involved in an outbreak.

Should you have your child get a blood test to see if he really did pick up the illness after being exposed? No. Unfortunately, the blood test won't show up until after your child has started feeling sick. If your child does become sick, then it IS important to get a blood test to confirm the diagnosis so the public health department can help you control further spread of the illness to family members, friends, and the general public.

No, unfortunately there is nothing can be done after hours. Please contact your physician during regular business hours.